Objectives: Over the last two decades, mean number of otolaryngology applications-per-candidate has increased by 250%. Otolaryngology-specific requirements were piloted to minimize applicant and program burdens. We investigated the impact of introducing and then removing these pre-match requirements on Match outcomes. Methods: 2014–2021 National Resident Matching Program® (NRMP) data was examined. Primary outcome was impact of otolaryngology resident talent assessment (ORTA; conducted pre-match 2017, post-match 2019) and program specific paragraph (PSP; implemented 2016, made optional 2018) on applicant numbers and match rates. Secondary analysis of a survey distributed to post-graduate year one and two (PGY-1/PGY-2) otolaryngology residents assessed candidate perceptions. Results: Applicant numbers declined significantly during PSP/ORTA (18.9%,P=0.001). After changes to optional PSP and post-match ORTA, applicant numbers increased significantly (39.0%,P=0.002). Examined individually, mandatory PSP was associated with a significant decline in applicants (P=0.007), whereas post-match ORTA was associated with significant increases in applicants (P=0.010). ORTA and PSP negatively impacted the decision to apply into otolaryngology in 59.8% and 51.3% of applicants, respectively. Conversely, match rate success improved significantly from 74.8% to 91.2% during PSP/ORTA (P=0.014), followed by significant decline to 73.1% after PSP was made optional and ORTA moved to post-match (P=0.002). Conclusion: Both the ORTA and PSP were associated with declines in applicant numbers and increases in match rate success. The ORTA move to post-match demonstrated the most impact on increasing candidate numbers. As programs seek ways to remove barriers to applying into otolaryngology, the potential consequences of an increasing pool of unmatched candidates must also be considered.
